II 110th CONGRESS 1st Session S. 1824 IN THE SENATE OF THE UNITED STATES July 19, 2007 Mr. Obama introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to establish a Hospital Quality Report Card Initiative under the Medicare program to assess and report on health care quality in hospitals.

1.

Short title

This Act may be cited as the Hospital Quality Report Card Act of 2007.

2.

Purpose

The purpose of this Act is to expand hospital quality reporting by establishing the Hospital Quality Report Card Initiative under the Medicare program to ensure that hospital quality measures data are readily available and accessible in order to— (1)assist patients and consumers in making decisions about where to get health care; (2)assist purchasers and insurers in making decisions that determine where employees, subscribers, members, or participants are able to go for their health care; and (3)assist health care providers in identifying opportunities for quality improvement and cost containment.

3.

Hospital quality report card initiative

(a)

In general

Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section:

1898.

Hospital Quality Report Card Initiative

(a)

In general

Not later than 18 months after the date of the enactment of the Hospital Quality Report Card Act of 2007, the Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as the Administrator) and in consultation with the Director of the Agency for Healthcare Research and Quality, shall, directly or through contracts with States or appropriate entities (such as utilization and quality control peer review organizations under part B of title XI, commonly known as Quality Improvement Organizations), establish and implement a Hospital Quality Report Card Initiative (in this section referred to as the Initiative) to report on health care quality in subsection (d) hospitals. (b)

Subsection (d) hospital

For purposes of this section, the term subsection (d) hospital has the meaning given such term in section 1886(d)(1)(B). (c)

Requirements of initiative

(1)

Quality measurement reports for hospitals

(A)

Quality measures

Not less than 2 times each year, the Secretary shall publish reports on hospital quality. Such reports shall include quality measures data submitted under section 1886(b)(3)(B)(viii), and other data as feasible, that allow for an assessment of health care— (i)effectiveness; (ii)safety; (iii)timeliness; (iv)efficiency; (v)patient-centeredness; and (vi)equity. (B)

Report Card features

In collecting and reporting data as provided for under subparagraph (A), the Secretary shall include hospital information, as possible, relating to— (i)staffing levels of nurses and other health professionals, as appropriate; (ii)rates of hospital acquired infections; (iii)the volume of various procedures performed; (iv)the availability of interpreter services on-site; (v)the accreditation of hospitals, as well as sanctions and other violations found by accreditation or State licensing boards; (vi)the quality of care for various patient populations, including pediatric populations and racial and ethnic minority populations; (vii)the availability and accessibility of emergency rooms, including measures of crowding such as diversion status, patient boarding in the emergency room, and untreated patients due to extended wait time; (viii)the availability of intensive care units, obstetrical units, and burn units; (ix)the quality of care in various hospital settings, including inpatient, outpatient, emergency, maternity, and intensive care unit settings; (x)the use of health information technology, telemedicine, and electronic medical records; (xi)ongoing patient safety initiatives; and (xii)other measures determined appropriate by the Secretary. (C)

Tailoring of hospital quality reports

The Director of the Agency for Healthcare Research and Quality may modify and publish hospital reports to include quality measures for diseases and health conditions of particular relevance to certain regions, States, or local areas. (D)

Risk adjustment

(i)

In general

In reporting data as provided for under subparagraph (A), the Secretary may risk adjust quality measures to account for differences relating to— (I)the characteristics of the reporting hospital, such as licensed bed size, geography, teaching hospital status, and profit status; and (II)patient characteristics, such as health status, severity of illness, insurance status, and socioeconomic status. (ii)

Availability of unadjusted data

If the Secretary reports data under subparagraph (A) using risk-adjusted quality measures, the Secretary shall establish procedures for making the unadjusted data available to the public in a manner determined appropriate by the Secretary. (E)

Costs and charges

The Secretary shall— (i)compile data relating to the average hospital cost and charges for ICD–9 conditions for which quality measures data are collected; and (ii)report such information in a manner that allows cost and charge comparisons between or among subsection (d) hospitals. (F)

Verification

Under the Initiative, the Secretary may verify data reported under this paragraph to ensure accuracy and validity. (G)

Disclosure

The Secretary shall disclose the entire methodology for the reporting of data under this paragraph to all relevant organizations and all subsection (d) hospitals that are the subject of any such information that is to be made available to the public prior to the public disclosure of such information. (H)

Public input

The Secretary shall provide an opportunity for public review and comment with respect to the quality measures to be reported for subsection (d) hospitals under this section for at least 60 days prior to the finalization by the Secretary of the quality measures to be used for such hospitals. (I)

Availability of reports and findings

(i)

Electronic availability

The Secretary shall ensure that reports are made available under this section in an electronic format, in an understandable manner with respect to various populations (including those with low functional health literacy), and in a manner that allows health care quality comparisons to be made between local hospitals. (ii)

Findings

The Secretary shall establish procedures for making report findings available to the public, upon request, in a nonelectronic format, such as through the toll-free telephone number 1–800–MEDICARE. (J)

Identification of methodology

The analytic methodologies and limitations on data sources utilized by the Secretary to develop and disseminate the comparative data under this section shall be identified and acknowledged as part of the dissemination of such data, and include the appropriate and inappropriate uses of such data. (K)

Adverse selection of patients

On at least an annual basis, the Secretary shall compare quality measures data submitted by each subsection (d) hospital under section 1886(b)(3)(B)(viii) with data submitted in the prior year or years by the same hospital in order to identify and report actions that would lead to false or artificial improvements in the hospital’s quality measurements, including— (i)adverse selection against patients with severe illness or other factors that predispose patients to poor health outcomes; and (ii)provision of health care that does not meet established recommendations or accepted standards for care. (2)

Data safeguards

(A)

Unauthorized use and disclosure

The Secretary shall develop and implement effective safeguards to protect against the unauthorized use or disclosure of hospital data that is reported under this section. (B)

Inaccurate information

The Secretary shall develop and implement effective safeguards to protect against the dissemination of inconsistent, incomplete, invalid, inaccurate, or subjective hospital data. (C)

Identifiable data

The Secretary shall ensure that identifiable patient data shall not be released to the public. (d)

Grants and technical assistance

The Secretary may award grants to national or State organizations, partnerships, utilization and quality control peer review organizations under part B of title XI, or other entities that may assist with hospital quality improvement. (e)

Hospital quality advisory committee

(1)

Establishment

The Administrator, in consultation with the Director of the Agency for Healthcare Research and Quality, shall establish the Hospital Quality Advisory Committee (in this subsection referred to as the Advisory Committee) to provide advice to the Administrator on the submission, collection, and reporting of quality measures data. The Administrator shall serve as the chairperson of the Advisory Committee. (2)

Membership

The Advisory Committee shall include representatives of the following (except with respect to subparagraphs (A) through (D), to be appointed by the Administrator): (A)The Agency for Healthcare Research and Quality. (B)The Health Resources and Services Administration. (C)The Department of Veterans Affairs. (D)The Centers for Disease Control and Prevention. (E)National membership organizations that focus on health care quality improvement. (F)Public and private hospitals. (G)Physicians, nurses, and other health professionals. (H)Patients and patient advocates. (I)Health insurance purchasers and other payers. (J)Health researchers, policymakers, and other experts in the field of health care quality. (K)Health care accreditation entities. (L)Representatives of utilization and quality control peer review organizations under part B of title XI. (M)Other agencies and groups as determined appropriate by the Administrator. (3)

Duties

The Advisory Committee shall review and provide guidance and recommendations to the Administrator on— (A)the establishment of the Initiative; (B)integration and coordination of Federal quality measures data submission requirements, to avoid needless duplication and inefficiency; (C)legal and regulatory barriers that may hinder quality measures data collection and reporting; and (D)necessary technical and financial assistance to encourage quality measures data collection and reporting. (4)

Staff and resources

The Administrator shall provide the Advisory Committee with appropriate staff and resources for the functioning of the Advisory Committee. (5)

Duration

The Advisory Committee shall terminate at the discretion of the Administrator, but in no event later than 5 years after the date of enactment of this section. (f)

Authorization of appropriations

There are authorized to be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2008 through 2017.

. (b)

Conforming Amendment

Section 1886(b)(3)(B)(viii)(VII) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(viii)(VII)), as added by section 5001 of the Deficit Reduction Act of 2005, is amended to read as follows: (VII)The Secretary shall use the data submitted under this clause for the Hospital Quality Report Card Initiative under section 1898. .

4.

Evaluation of the Hospital Quality Report Card Initiative

(a)

In general

The Director of the Agency for Healthcare Research and Quality, directly or through contract, shall evaluate and periodically report to Congress on the effectiveness of the Hospital Quality Report Card Initiative established under section 1898 of the Social Security Act, as added by section 3, including the effectiveness of the Initiative in meeting the purpose described in section 2. The Director shall make such reports available to the public. (b)

Research

The Director of the Agency for Healthcare Research and Quality, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, shall use the outcomes from the evaluation conducted pursuant to subsection (a) to increase the usefulness of the Hospital Quality Report Card Initiative, particularly for patients, as necessary.